STUDY DESIGN: A review of controlled trials. OBJECTIVES: To determine which interventions are used to prevent back and neck pain problems as well as what the evidence is for their utility. SUMMARY OF BACKGROUND DATA: Given the difficulty in the successfully treating long-term back and neck pain, there has been a call for preventative interventions. Little is known, however, about the value of preventive efforts for nonpatients eg, in the general population or workplace. METHODS: The literature was systematically searched to locate all investigations that were (1) specifically designed as preventative intervention; (2) randomised or nonrandomised controlled trials; and, (3) using subjects not seeking treatment. Outcome was evaluated on the key variables of reported pain, report of injury, dysfunction, time off work, health-care utilisation, and cost. Conclusions were drawn using a grading system. RESULTS: Twenty-seven investigations meeting the criteria were found for educational efforts, lumber supports, exercises, ergonomics, and risk factor modification. For back schools, only one of the nine randomised trials reported a significant effect, and there was strong evidence that back schools were not effective in prevention. Because no properly controlled trials were found for ergonomic intervention or risk factor modification, there was not good quality evidence available to draw a conclusion. CONCLUSIONS: The results concerning prevention for subjects not seeking medical care are sobering. Only exercises provided sufficient evidence to conclude ht they are an effective preventative intervention. There is a dire lack of controlled trials examining broad-based maultidimensional programs. The need for high quality outcome studies is underscored.
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